Kinematic Gait Parameters Research Articles

The ability of gait kinematic parameters to predict falls in older adults with cognitive impairments living in long term institutions

BackgroundCognitive impairments reduce adaptive responses and may increase the risk of falls. ObjectivesTo compare gait kinematics in older adults with cognitive impairments living in long term institutions and to identify the ability of gait kinematics to predict falls in older adults with cognitive impairments living in long term institutions. MethodsData of 23 older adults with cognitive impairments living in long term institutions were considered for this study. Fifty gait cycles were recorded during walking at a self-selected pace using footswitches sensors. The variables considered for the analysis were: speed; stride length; stance, swing and stride time; and the variability of these parameters. Fall status was recorded for a 6 month-period. FindingsMANOVA found group effect (p = 0.025) for gait kinematics comparisons. Variability of stance (p = 0.01) and swing (p = 0.012) and stride time (p < 0.001) were higher in older fallers. Speed of older fallers was 31.8% slower than those of the non-fallers (p < 0.001). The kinematic variables that were able to predict falls were: stride time variability (p < 0.001), threshold of 0.4 s, sensitivity of 50% and specificity of 100%; and gait speed (p < 0.001), threshold of 0.65 m·s−1, sensibility and specificity of 50%. InterpretationOlder adults living in an assisted living facility with a history of falls demonstrate increased kinematic variability while walking. However, the ability of gait kinematic parameters to predict falls was found to be weak. The results suggested that gait kinematic parameters are weak predictors of falls in older adults with cognitive impairments living in long term institutions.

Walking With a Weighted Pelvic Belt or With an Equivalent Pure Downward Force on the Pelvis: Are These Different?

In a previous study, a tethered pelvic-assist device (TPAD) was used to successfully retrain crouch gait in children with cerebral palsy by applying a downward force on the pelvis while walking on a treadmill. While the results of this study were promising, an important issue was to translate this training to the children in a more practical manner. This motivated the question in this letter whether a different intervention could result in similar improvements in the gait as seen with the TPAD. This is the motivation for this study, which compares the biomechanical differences in walking under the following two conditions. 1) The TPAD applies a pure downward force on the pelvis using tethers. 2) A weighted pelvic belt is used to apply the same downward force on the pelvis. In this case, the weight belt also increases the mass at the pelvis. A total of ten healthy subjects performed two separate experiments while walking on an instrumented treadmill. The whole-body kinematics were recorded using a motion-capture system, and the ground reaction forces were measured by the force plates embedded in the treadmill. We found no significant differences in the kinematic gait parameters of healthy subjects when the downward force, equivalent to 15% body weight, applied by the TPAD was replaced by a weighted pelvic belt having 15% body weight. However, the activation of the gastrocnemius muscle and the estimated maximum ankle torque, predicted by an inverted pendulum mathematical model, during the single support phase of walking, showed a higher increase with the weight belt when compared to a pure downward force. Thus, the weight belt, because of its simplicity, must be further considered as a more convenient candidate to translate the results of TPAD in children with cerebral palsy who suffer from crouch gait.

Gait Analysis of Patients Subjected to the Atrophic Mandible Augmentation with Iliac Bone Graft.

In this study, we aimed to quantitatively monitor and describe the gait functions of patients, who underwent iliac crest bone grafting in atrophic jaw augmentation operation, by taking into account the alterations of gait parameters and muscle forces in the early recovery course. To do so, temporospatial and kinematic gait parameters of ten patients during pre- and postoperative periods were recorded, and forces of the gluteus medius, gluteus maximus, and iliacus muscles were calculated. Three postoperative periods were specified as one week (post-op1), two weeks (post-op2), and three weeks (post-op3) after the surgery. Restoring process of the gait patterns was comparatively evaluated by analyzing the gait parameters and muscle forces for pre- and postoperative periods. Temporospatial and kinematic parameters of post-op3 were closer to those obtained in pre-op than those in post-op1 and post-op2 (p < 0.05). Muscle forces calculated in post-op3 showed the best agreement with those in pre-op among the postoperative periods in terms of both magnitude and correlation (p < 0.05). In conclusion, the patients began to regain their preoperative gait characteristics from the second week after surgery, but complete recovery in gait was observed three weeks after the surgery.

Transtibial amputee gait with the unity suspension system

Study Design: Experimental study.Objectives: Research is lacking on the Unity suspension system’s effect on gait performance. The purpose of this study was to evaluate the effects of the Unity elevated vacuum system on level walking performance while the vacuum was active (ON) and inactive (OFF).Methods: Twelve unilateral transtibial amputees were fit with the Ossur elevated vacuum suspension system (Unity) and Pro-flex XC foot. After one month accommodation period, 3D motion analysis was performed using the CAREN-Extended system. Temporal-spatial, kinematics, and kinetics were examined during level walking to understand the effect of the elevated vacuum, separate trials were completed with the vacuum active (ON) or inactive (OFF).Results: Significant differences were found between vacuum conditions (ON and OFF) for some temporal-spatial gait parameters, but differences were very small and may not be clinically significant. Differences between vacuum conditions on most kinetic and kinematic gait parameters were also low. However, step length symmetry between intact and prosthetic limbs improved with active elevated vacuum (ON).Conclusions: Elevated vacuum suspension’s effect on level walking gait is small if a well-fitting liner-based socket is provided.Implications for rehabilitationStep length symmetry between intact and prosthetic limbs improved with an active vacuum system.Differences between vacuum conditions on most gait parameters were small during level walking.Subjective feedback showed improved proprioception and comfort with an active vacuum system.

Immediate effects of a single treadmill session with additional ankle loading on gait in children with hemiparetic cerebral palsy.

Children with hemiparetic cerebral palsy are often characterized by reduced speed progression, shorter step length, and increased support base. These kinematic alterations result in inefficient gait. To assess the immediate effects of treadmill training with additional lower limb loading on kinematic gait parameters in children with Cerebral Palsy (CP). This cross-sectional, observational study, involved 20 children with hemiparetic CP that underwent single treadmill session with ankle loading. Kinematic gait data were collected by the Qualisys Motion Capture System during baseline (PRE), immediately after training (POST) and 5 minutes after post session (FOLLOW UP). The results demonstrated increase in knee (p = 0.001) and hip (p = 0.005) range of motion, maximum knee (p <.0.001) and hip (p =.001) flexion in swing and paretic foot height during swing (p <0.001) when PRE x POST were compared. Treadmill gait training with additional lower limb loading was a disturbance capable of modifying the locomotor strategy of these population. The increase in hip flexion during swing phase allowed higher paretic foot clearance which may favor the improvement of gait function.

Does the first trimester of pregnancy induce alterations in the walking pattern?

IntroductionFrom among many studies observing the walking pattern throughout pregnancy, only two items monitor the influence of pregnancy on the movement system during gait considering the period before gestation.Research questionDoes the women’s gait pattern at the end of the first trimester undergo changes in comparison to body movement pattern before pregnancy?MethodsAll subjects who met the inclusion criteria gave signed and informed consent before the study. Two experimental sessions were arranged according to the same protocol: (P0) before pregnancy and (P1) at the end of the first trimester of pregnancy (12th week of gestation). At first the anthropometric measures were taken. Then, walking trials at a self-selected speed along a walkway were registered with Vicon 250 (Oxford Metrics Ltd.; Oxford, UK) and FreeMED force platform (Sensor Medica, Italy).ResultsAn analysis of anthropometric parameters in 12th pregnancy week demonstrated significant changes in mean values of waist circumference and waist to hip ratio as well as waist to height ratio indexes compared to the results before pregnancy. No significant differences were found in the basic kinematic gait parameters between experimental conditions. Significant increase of mean inter—ankle distance during double support phase occurred during the first trimester of pregnancy. Also, the ratio of the ankle separation width to the pelvic width was noticeably higher in gestation. Then, angular changes of the pelvis in coronal and transverse planes throughout gait cycle during pregnancy demonstrated significant differences compared to those measured before pregnancy. At the same time in the first trimester of pregnancy no adaptive changes in the pattern of feet loading take place.SignificanceSince our study is of longitudinal character, in the course of pregnancy we expect compensatory mechanisms more clearly demonstrated. Therefore, we hope to identify a strategy of the gravid body progression in space.

Walking With a Robotic Exoskeleton Does Not Mimic Natural Gait: A Within-Subjects Study.

BackgroundRobotic exoskeleton devices enable individuals with lower extremity weakness to stand up and walk over ground with full weight-bearing and reciprocal gait. Limited information is available on how a robotic exoskeleton affects gait characteristics.ObjectiveThe purpose of this study was to examine whether wearing a robotic exoskeleton affects temporospatial parameters, kinematics, and muscle activity during gait.MethodsThe study was completed by 15 healthy adults (mean age 26.2 [SD 8.3] years; 6 males, 9 females). Each participant performed walking under 2 conditions: with and without wearing a robotic exoskeleton (EKSO). A 10-camera motion analysis system synchronized with 6 force plates and a surface electromyography (EMG) system captured temporospatial and kinematic gait parameters and lower extremity muscle activity. For each condition, data for 5 walking trials were collected and included for analysis.ResultsDifferences were observed between the 2 conditions in temporospatial gait parameters of speed, stride length, and double-limb support time. When wearing EKSO, hip and ankle range of motion (ROM) were reduced and knee ROM increased during the stance phase. However, during the swing phase, knee and ankle ROM were reduced when wearing the exoskeleton bionic suit. When wearing EKSO, EMG activity decreased bilaterally in the stance phase for all muscle groups of the lower extremities and in the swing phase for the distal muscle groups (tibialis anterior and soleus) as well as the left medial hamstrings.ConclusionsWearing EKSO altered temporospatial gait parameters, lower extremity kinematics, and muscle activity during gait in healthy adults. EKSO appears to promote a type of gait that is disparate from normal gait in first-time users. More research is needed to determine the impact on gait training with EKSO in people with gait impairments.

Normal and pathological gait classification LSTM model.

Computer vision-based clinical gait analysis is the subject of permanent research. However, there are very few datasets publicly available; hence the comparison of existing methods between each other is not straightforward. Even if the test data are in an open access, existing databases contain very few test subjects and single modality measurements, which limit their usage. The contributions of this paper are three-fold. First, we propose a new open-access multi-modal database acquired with the Kinect v.2 camera for the task of gait analysis. Second, we adapt to use the skeleton joint orientation data to calculate kinematic gait parameters to match golden-standard MOCAP systems. We propose a new set of features based on 3D low-limbs flexion dynamics to analyze the symmetry of a gait. Third, we design a Long-Short Term Memory (LSTM) ensemble model to create an unsupervised gait classification tool. The results show that joint orientation data provided by Kinect can be successfully used in an inexpensive clinical gait monitoring system, with the results moderately better than reported state-of-the-art for three normal/pathological gait classes.

The gait deviations of ankylosing spondylitis with hip involvement.

The aim of the study was to investigate the gait deviations of ankylosing spondylitis (AS) patients with hip involvement. Thirty-six subjects, including 18 AS patients with hip involvement (AS group) and 18 healthy people (control subjects, CS group), were enrolled in the study. Three-dimensional gait analysis of the AS group and CS group was performed. Kinematic parameters, kinetic parameters and surface electromyography (sEMG) during the gait cycle were measured. The AS patients with hip involvement had a lower gait velocity, shorter step length and shorter stride length. In the hip angles, there was significantly decreased flexion, excessive abduction and excessive external rotation; there was excessive flexion in the knee and reduction in plantar flexion of the ankle. AS patients had increased forward trunk flexion, excessive obliquity and restricted rotation of the trunk during the gait cycle. The hip moments of the AS group showed a significant reduction in flexion, abduction and external rotation during the gait cycle. The root mean square amplitude of the sEMG for the rectus femoris in the AS group was higher than that in the CS group. The gait deviations in AS patients with hip involvement were described in this study. The gait analysis results demonstrated statistically significant alterations regarding the kinematic and kinetic gait parameters for the patients included in the sample. Coordination and balance were impaired by the disease. An efficient physical exercise plan can be formulated according to the results of gait analysis.

Effect of Trunk Muscle Strengthening on Gait Pattern and Falls in Parkinson's Disease.

BackgroundThe course of Parkinson’s disease is characterized by gait disturbance and falls, which affect patients’ quality of life and engender high healthcare costs. These factors are not greatly improved by levodopa therapy or deep brain stimulation of the subthalamic nuclei. Indeed, the symptoms may even worsen with these treatment. Physiotherapy may be the most appropriate treatment to reduce the incidence of falls in these cases; however, its benefits are modest.ObjectiveTo assess the effectiveness of trunk muscle strengthening in 10 patients with Parkinson’s disease being treated with deep brain stimulation of the subthalamic nuclei who are affected by gait disturbances and falls.MethodA standardized physiotherapy programme centred on trunk muscle strengthening was conducted. Its effectiveness was assessed using a clinical approach combined with video-based motion analysis.ResultsAfter 4 weeks of trunk muscle strengthening, the gait item on the Unified Parkinson’s Disease Rating Scale (UPDRS, part 3) together with several gait kinematic parameters (step length, walking cycle duration variability, gait speed) were significantly improved and the number of falls decreased.ConclusionThese preliminary findings suggest that physiotherapy centred on rachis mobility improves the quality of gait and reduces the number of falls in patients with Parkinson’s disease who are being treated with deep brain stimulation of the subthalamic nuclei. This is a potentially useful supplement to the traditional physiotherapy approach, in addition to the pharmacological and surgical treatment of Parkinson’s disease.LAY ABSTRACTOver time, patients with Parkinson’s disease treated operatively with subthalamic nucleus deep brain stimulation develop drug-resistant gait disturbance and falls. Traditional physiotherapy programmes for reducing the incidence of falls in these patients have modest effects. Thus, a physiotherapy programme based on trunk exercises could be helpful, since optimal axial motility and gait and posture quality are strongly linked. A specific programme was used for 10 patients with Parkinson’s disease treated operatively with subthalamic nucleus deep brain stimulation. The programme involved 2 physiotherapy sessions per day for 5 days a week over a period of 4 consecutive weeks. Quality of gait improved and the number of falls decreased significantly. In conclusion, specific standardized rehabilitation of axial motility is potentially a useful supplement to the traditional physiotherapy approach in order to reduce falls in patients with Parkinson’s disease who have been treated operatively with subthalamic nucleus deep brain stimulation.

The new approach in the treatment of walking disorders in Parkinson's disease

To evaluate the efficacy of a proprietary method based on stimulation of the hindfoot when lifting the foot from the surface of the support and bringing it forward in the treatment of walking disorders in patients with Parkinson's disease (PD). The study included 19 patients with walking disorders, akinetic-rigid and mixed form of PD. The stage of the disease on the Hoehn-Yahr scale at the time of the study was 2.56±0,41. During the treatment of walking disorders using the proprietary method, correction of anti-parkinsonian therapy was not carried out. Correction of walking disorders was carried out by using 'activating platforms', which allow mechanical stimulation of the hindfoot at the moment of lifting the foot from the surface of the support. Neurological examination, computer stabilometry (CS), gait function evaluation by means of the LA-1 laser analyzer of kinematic parameters of gait, Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Unified Parkinson's Disease Rating Scale (UPDRS) were used before and after treatment. A significant decrease in core values of LA-1 and positive dynamics on BBS, DGI, UPDRS was revealed after treatment. The original method based on stimulation of foot lifting from the surface and moving the foot forward, effectively improves the pattern of walking in patients with PD and can be recommended as a non-pharmacological method of treatment of impaired walking at the third stage of PD.

Changes in kinematic parameters during walking in adults with low back pain subjected to Vojta therapy. A pilot study

IntroductionThe aim of the study was to evaluate changes in selected basic and derivative kinematic parameters of gait in adult patients with low back pain subjected to Vojta therapy.MethodsThe study included 17 patients with low back pain subjected to Vojta therapy. Gait parameters were assessed with G-SENSOR, the wireless inertial measurement unit system for gait analysis. The device was placed on the body of the patient in the lumbar region at the level of L4–L5, and enabled to obtain accurate and objective information on kinematic gait parameters.ResultsOut of the 17 spatial and temporal parameters analysed, 3 changed significantly. The cadence decreased, and the duration of the right and left limb walk cycles increased.ConclusionsRehabilitation with Vojta therapy may improve spatial and temporal gait parameters in adults with low back pain.

The Wisconsin gait scale – The minimal clinically important difference

BackgroundWisconsin Gait Scale (WGS) is an observational tool for the evaluation of gait quality in individuals after stroke with hemiplegia. It is divided into four subscales, which assess a total of fourteen spatiotemporal and kinematic parameters of gait observed during the consecutive gait phases. However, the WGS score change indicative of important and clinically meaningful change has not been determined. Research questionThe study has been designed to define the minimal clinically important difference (MCID) of the WGS. MethodsFour methods were used to determine the MCID for the WGS in 50 participants who had experienced a stroke: anchor-based study, distribution-based study, linear regression analysis and specification of the receiver operating characteristic (ROC) curve. ResultsIn the anchor-based study, the mean change score in the MCID group was 1.9 points (the first MCID estimate). In the distribution-based study, the standard error of measurement for the no-change group was 0.3 (the second MCID estimate). The slope of the regression line was 1.21 which means than 1-point change in the Barthel Index (BI) is associated with 1.21-point change in the WGS. This translates to 2.25 points change in the WGS with 1.85 points change in the BI (the third MCID estimate). The best cut-off point, determined with ROC curve, was the value corresponding to 1 point of change in the WGS (the fourth MCID estimate). SignificanceWe established that the MCID of the WGS was 2.25 points, based on the largest of the four MCID estimates. The value 2.25 of the MCID can help clinicians and researchers determine if the change in the scores on the WGS is clinically important. Clinical trial registrationData are parts of the following clinical trial: ACTRN12617000436370.

TRANSTIBIAL AMPUTEE GAIT WITH THE PRO-FLEX FOOT DURING LEVEL, DECLINE, AND INCLINE WALKING

INTRODUCTION&#x0D; The Össur Pro-Flex is a 3-blade carbon fiber prosthetic foot designed to provide greater ankle range of motion compared to conventional energy storing and returning prosthetic feet1,2. To provide knowledge on Pro-Flex biomechanical performance, kinematic and kinetic gait parameters were evaluated and compared with the Össur Pro-Flex XC prosthetic foot. Outcomes from this study provide clinical professionals with important decision-making knowledge about two innovative energy storing and returning prosthetic feet.&#x0D; Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32003/24424&#x0D; How to cite: Tomkin M, Gholizadeh H, Sinitski E, Lemaire E.D. TRANSTIBIAL AMPUTEE GAIT WITH THE PRO-FLEX FOOT DURING LEVEL, DECLINE, AND INCLINE WALKING. CANADIAN PROSTHETICS &amp; ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32003 &#x0D; Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. &#x0D; http://www.aopanet.org/

Dynamic alignment using external socket reaction moments in trans-tibial amputees

BackgroundProsthetic alignment is used to optimize prosthetic functioning and comfort. Spatio-temporal and kinematic gait parameters are generally observed to guide this process. However, they have been shown to be influenced by compensations, which reduces their sensitivity to changes in alignment. Alternatively, the use of moments working at the base of the prosthetic socket, external socket reaction moments (ESRM), has been proposed to quantify prosthetic alignment. Research questionTo investigate if a predetermined kinetic alignment criterion, 0Nm averaged over the stance phase, can be used to fine-tune prosthetic alignment. Methods10 transtibial amputees were included in this intervention study. Firstly, their prostheses were aligned using conventional alignment procedures. Kinetic parameters and Socket Comfort Score (SCS) were measured in this initial alignment (IA) condition. Subsequently, the coronal plane ESRM during gait was presented to the prosthetist in real time using a Gait Real-time Analysis Interactive Lab. The prosthetist iteratively adapted the prosthetic alignment towards a predetermined average ESRM during the stance phase of 0 Nm. At the Final Alignment (FA), kinetic parameters and SCS were measured again and a paired sample t-test was performed to compare ESRMs and SCSs between alignments. ResultsA significant (p < 0.001) change was found in the absolute coronal plane ESRM (mean ± SD) from IA (|0.104| ± 0.058 Nm/kg) to FA (|0.012| ± 0.015 Nm/kg). In addition a significant (p < 0.001) change of the external coronal adduction knee moments was observed from IA (−0,127 ± 0.079 Nm/kg) to FA (−0.055 ± 0.089 Nm/kg), however this change was more variable among participants. On average, no significant (p = 0.37) change in the SCS was observed. SignificanceWhile this study shows the potential of quantifying and guiding alignment with the assistance of kinetic criteria, it also suggests that a sole reliance on the ESRM as a single alignment criterion might be too simple.

Donor-Site Morbidity After Osteocutaneous Free Fibula Transfer: Longitudinal Analysis of Gait Performance

The purpose was to evaluate donor-site clinical morbidity and changes in kinematic gait parameters after the harvest of a vascularized free fibula flap for facial reconstruction. We enrolled 14 patients (aged 50±15years) in a longitudinal study. Every patient underwent a double evaluation in which a presurgical assessment and 6-month postsurgical assessment were performed. Subjective donor-site evaluation was carried out through unstructured clinical questioning about pain, paresthesia, walking ability, and restrictions in activity. Further subjective evaluations were assessed through the Western Ontario and McMaster Universities Osteoarthritis Index and the Point Evaluation System for Lower Extremity Fibulectomy. A clinical evaluation of the donor site assessed muscular deficits, sensibility disturbance, and wound healing. Temporal and spatial kinematic parameters were measured through gait analysis during overground walking at a comfortable speed. Postsurgical clinical examinations detected 1 patient affected by a neurologic disorder and 3 patients with donor-site pain, whereas 10 patients (71%) declared no residual alterations in the operated leg. On average, the Western Ontario and McMaster Universities Osteoarthritis Index score was 367 of 2,400, and the Point Evaluation System for Lower Extremity Fibulectomy score was 19 of 24. Presurgical versus postsurgical gait analysis comparison showed no significant differences in gait parameters except for a 6% reduction in the double-support phase.Stance values were higher for the operated limb in both evaluations (+1.3% before surgery,+1.8% after surgery). No alterations were detected in the range of motion of the lower-limb joints. Considering the slight modification of the gait pattern, which is not usually perceived by patients, vascularized free fibula flap harvest was generally associated with successful functional and subjective outcomes of the donor site.

Men and women with Down syndrome exhibit different kinematic (but not spatio-temporal) gait patterns.

Gait phenotypes are well documented in people with Down syndrome (pwDS), but sex-related differences are still unexplored. This study investigated the existence of possible differences in spatio-temporal and kinematic parameters of gait between men and women with DS using quantitative three-dimensional gait analysis. Gait patterns of 117 pwDS (53 F, 64 M) who underwent a computerised gait analysis from 2002 to 2017 were retrospectively analysed to obtain spatio-temporal gait parameters and kinematics in the sagittal plane at hip, knee and ankle joints, as well as foot progression. Overall, when considered as a single group, the gait patterns found for pwDS confirmed the findings of previous studies. However, when analysed by sex, our data revealed that women with DS exhibit a larger hip flexion at late stance (42% to 54% of the gait cycle) and reduced knee flexion at the beginning of the swing phase (61% to 69% of the gait cycle). In contrast, men are characterised by larger foot extra-rotation angles through most of the stance phase (from 0% to 55% of the gait cycle) and at the end of the swing phase (92% to 99% of the gait cycle). No differences between men and women with DS were found concerning ankle dorsi- plantar-flexion or in all spatio-temporal parameters normalised by individuals' anthropometry, excluding cadence (higher in women). The findings of the present study highlight the need to investigate gait dysfunctions in pwDS by taking their sex into consideration. Such an approach may be useful not only in gaining a better understanding of the pathophysiology of gait disturbances associated with DS but also in supporting a better orientation of rehabilitative treatments.

Association between Objectively Measured Physical Activity and Gait Patterns in People with Parkinson's Disease: Results from a 3-Month Monitoring.

Background Although physical activity (PA) is known to be beneficial in improving motor symptoms of people with Parkinson's disease (pwPD), little is known about the relationship between gait patterns and features of PA performed during daily life. Objective To verify the existence of possible relationships between spatiotemporal and kinematic parameters of gait and amount/intensity of PA, both instrumentally assessed. Methods Eighteen individuals affected by PD (10F and 8M, age 68.0 ± 10.8 years, 1.5 ≤ Hoehn and Yahr (H&Y) < 3) were required to wear a triaxial accelerometer 24 h/day for 3 consecutive months. They also underwent a 3D computerized gait analysis at the beginning and end of the PA assessment period. The number of daily steps and PA intensity were calculated on the whole day, and the period from 6:00 to 24:00 was grouped into 3 time slots, using 3 different cut-point sets previously validated in the case of both pwPD and healthy older adults. 3D gait analysis provided spatiotemporal and kinematic parameters of gait, including summary indexes of quality (Gait Profile Score (GPS) and Gait Variable Score (GVS)). Results The analysis of hourly trends of PA revealed the existence of two peaks located in the morning (approximately at 10) and in the early evening (between 18 and 19). However, during the morning time slot (06:00–12:00), pwPD performed significantly higher amounts of steps (4313 vs. 3437 in the 12:00–18:00 time slot, p < 0.001, and vs. 2889 in the 18:00–24:00 time slot, p=0.021) and of moderate-to-vigorous PA (43.2% vs. 36.3% in the 12:00–18:00 time slot, p=0.002, and vs. 31.4% in the 18:00–24:00 time slot, p=0.049). The correlation analysis shows that several PA intensity parameters are significantly associated with swing-phase duration (rho = −0.675 for sedentary intensity, rho = 0.717 for moderate-to-vigorous intensity, p < 0.001), cadence (rho = 0.509 for sedentary intensity, rho = −0.575 for moderate-to-vigorous intensity, p < 0.05), and overall gait pattern quality as expressed by GPS (rho = −0.498 to −0.606 for moderate intensity, p < 0.05) and GVS of knee flexion-extension (rho = −0.536 for moderate intensity, p < 0.05). Conclusions Long-term monitoring of PA integrated by the quantitative assessment of spatiotemporal and kinematic parameters of gait may represent a useful tool in supporting a better-targeted prescription of PA and rehabilitative treatments in pwPD.

An innovative microprocessor-based system for Human Activity Recognition: A fast and reliable classification algorithm

People with lower limb amputation may experience walking limitations on slopes because of missing musculoskeletal and neuromuscular systems. Elevated vacuum suspension could benefit transtibial amputee gait for slope walking, but research is lacking to inform clinical practice.Twelve people with unilateral transtibial amputation were fitted with the Unity elevated vacuum suspension system (Össur) and Pro-Flex XC foot. 3D motion analysis was performed for 7° incline, 7° decline, and level walking within a CAREN-Extended system virtual Park environment. Randomized and blinded walking trials were completed with the vacuum active or inactive.Statistically significant differences (p < 0.05) were found between vacuum conditions when walking uphill or downhill for temporal spatial, kinematic, and kinetic gait parameters; however, effect sizes were small (r≤0.35). Prosthetic step length decreased for both vacuum conditions on downhill compared to uphill walking. Symmetry index was <10% for step length, step time, and stance time for both vacuum condition during downhill walking, indicating acceptable symmetry. During incline walking, step length was only symmetrical with active vacuum. Knee range of motion was not restricted, for both conditions.Active vacuum improved gait symmetry for incline walking, but the other differences between vacuum conditions were small and may not be clinically significant. Therefore, the Unity system approach for elevated vacuum suspension had a positive, but small, effect on walking and should maintain appropriate walking even with vacuum failure, until limb volume changes adversely affect socket fit (i.e., elevated vacuum helps control limb volume fluctuations over time).

Research on gait kinematics parameters of unilateral transtibial amputees after wearing prostheses

Objective To analyze the gait kinematics parameters of patients with unilateral leg amputation after wearing prosthesis using the computer assisted rehabilitation environment (CAREN) gait assessment system, and the reasons for the differences. Methods Nine patients with unilateral mid-leg amputation were selected as the prosthesis group, and 11 healthy subjects were selected as the standard group. The gait kinematics parameters of the two groups were collected, processed and analyzed by using the CAREN gait evaluation system. Results The gait phase index of the prosthetic limb group was (0.88±0.04). Significant differences were observed between the prosthetic and healthy limbs in terms of step length, stance phase percentage, maximum hip extension angle and maximum knee flexion angle, maximum dorsiflexion and plantar flexion angle of the ankle joint during the stance phase, as well as the dorsiflexion angle of ankle joint during heel strike to the ground (P<0.05). Moreover, there were significant differences between the affected limbs of the prosthetic limb group and limbs of the standard group in terms of the walking speed, gait cycle, stride length, percentage of stance phase, hip flexion angle, knee flexion and ankle dorsiflexion during heel strike, maximum hip extension and flexion angle, maximum dorsi- and plantar-flexion of ankle joint during stance phase (P<0.05). Conclusion The relative symmetry of the gait of the unilateral leg amputee is (0.88±0.04), with their kinematics parameters of the prosthetic limb significantly weaker than those of the contralateral side and the healthy controls. Key words: Gait analysis; Computer assisted rehabilitation environment assessment system; Amputation; Kinematic parameters